Injury Line: R.B. Jergens Contractors, Inc.
| Inspection Nr | 304342934 |
| Investigation Nr | 201952892 |
| Line Nr | 3 |
| Age | |
| Sex |   |
| Nature of Injury | Fracture |
| Part of Body | Hip(S) |
| Source of Injury | Other |
| Event Type | Struck By |
| Environmental Factor | Flying Object Action |
| Human Factor | Other |
| Occupation | Occupation not reported |
| Degree of Injury | Non Hospitalized injury |
| Task Assigned | Task not regularly assigned |
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